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Parasomnias: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Parasomnias are behavioral phenomena that occur in connection with sleep. Parasomnias are typical for childhood and adolescence and often disappear as the child grows older. The diagnosis is clinical. Treatment is medication in combination with psychotherapy.
Night terrors are characterized by episodes of fear, screaming, often accompanied by sleepwalking. They are common among children and are observed only with incomplete awakening from stages III and IV of slow (non-REM) sleep, i.e. they are not nightmares. In adults, night terrors are often associated with mental disorders or chronic alcoholism. As a rule, medium- or long-acting benzodiazepines (e.g., clonazepam 1-2 mg orally, diazepam 2-5 mg orally) before bedtime are effective.
Nightmares (frightening dreams) are more common in children than in adults, and are observed during REM sleep, with fever or fatigue, and after drinking alcohol. Treatment consists of eliminating mental (emotional) disorders.
Rapid eye movement (REM) sleep behavior disorder is characterized by sleep talking and often violent movements (e.g., arm flailing, punching, kicking) during rapid eye movement (REM) sleep. Such behavior may be dream fulfillment provided that the muscle atonia characteristic of REM sleep is absent. This disorder is more common in the elderly, especially in degenerative diseases of the central nervous system (e.g., Parkinson's disease, Alzheimer's disease, vascular dementia, olivopontocerebellar degeneration, multiple system atrophy, progressive supranuclear palsy). Similar phenomena are observed in narcolepsy and the use of norepinephrine reuptake inhibitors (e.g., atomoxetine, reboxetine).
Polysomnography may reveal increased motor activity during REM sleep, and audiovisual monitoring records abnormal body movements and sleep talking. For correction, clonazepam is prescribed at 0.5-2 mg orally before bedtime. Spouses should be warned about the possibility of injury.
Night terrors are also observed in the 3rd and 4th sleep phases. The subject wakes up with a feeling of intense fear and anxiety, with signs of excitation of the autonomic nervous system. Such a person may run away screaming and may cause harm to others.
Nocturnal cramps, or cramps in the muscles of the lower leg or foot during sleep, occur in healthy young and older individuals. Diagnosis is based on history and absence of pathology on physical examination. Prevention is by stretching the involved muscles for several minutes before bedtime. Stretching is also an emergency treatment and stops cramps that have already begun, so it is preferable to drug therapy. A wide variety of drugs have been tried for the treatment of cramps (e.g., quinine, calcium and magnesium preparations, diphenhydramine, benzodiazepines, mexiletine), but none have proven effective, with many serious side effects (especially quinine and mexiletine). Avoiding caffeine and other sympathomimetics may also be effective.
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